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The 2010 Legislature had a
lot of ups and downs as our state legislators focused almost
exclusively on balancing the state’s budget. Despite the
somewhat uncertain times, our legislators made many decisions
that we consider good or appropriate for health care:
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Faced with significant
financial challenges, the legislators considered sweeping
changes in Medicaid that would have required virtually all
hospitals to contract with commercial Health Maintenance
Organizations and Provider Sponsored Networks, regardless of
how well these plans have performed for the benefit of their
patients. The two regions where experiments have been
underway for the past few years have yet to prove
successful, and expanding this concept to much or all of the
state would have been a bad decision.
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Presently all
hospitals pay 1.5 percent of all inpatient revenues and 1
percent of all outpatient revenues into a state fund that
helps draw down federal dollars. This is often referred to
as a “sick tax,” as it is imposed on patient revenues.
Legislators considered increasing the “sick tax” by
requiring hospitals to pay an additional $163 million to
help fund the Medicaid program. Fortunately, this tax
increase was dropped from further debate, at least for this
year.
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A 7 percent reduction
in Medicaid fee-for-service payments to hospitals did pass;
however, major safety-net hospitals such as Lee Memorial
Health System are allowed to offset a portion of this cut
through the use of what is referred to as Inter-governmental
Transfers. This means a net decrease of less than 3 percent
in Medicaid payments.
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A few years ago,
our state lawmakers adopted Red Light Runner legislation
that gave state trauma centers a portion of fines collected
by law enforcement officers from people who run red lights.
This year our lawmakers passed legislation adopting the
enforcement of camera technology to catch red light
violators. The bill earmarked $10 per ticket for Florida
Trauma Centers. While the net funding is somewhat limited,
there remains recognition at the legislative level that
broad-based funding for trauma is essential.
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Last year, as part of
the federal stimulus plan, the federal government
significantly increased its percentage of the federal/state
sharing for Medicaid funding. This is referred to as the
enhanced Federal Medical Assistance Percentage, or FMAP. As
of this moment, it is unclear as to whether the enhanced
FMAP will be expanded beyond this Dec. 31. Thus, our
legislators passed two versions of the budget: one assumes
the current enhanced FMAP levels through the end of December
2010, as federal law now states, and the other version
contains a six-month extension of enhanced FMAP, meaning the
funds would be available for the entire Florida fiscal year.
A six-month extension of enhanced FMAP would be most
advantageous for hospitals, meaning an additional nearly
$330 million for vital health services in Florida.
Lee Memorial Health System
participates in two key organizations that represent our
legislative needs in Florida and in Washington, D.C. The Florida
Hospital Association, which is the single largest unifying
entity of hospitals and health care organizations in the state,
and the Safety Net Alliance of Florida, which represents the
major public and teaching hospitals and health systems in
Florida, advocate for health care legislation and reform that
benefits the patients and citizens of Florida.
While we averted
significant economic pressures at the state level this year,
next year’s Legislature will face a much greater challenge
because the federal stimulus support through an enhanced FMAP
will most likely not be available. Thus legislative decisions
will be overshadowed by budget concerns even more than this
year. The next couple years there will be reductions in Medicare
and Medicaid reimbursement, and the concept of broader coverage
for uninsured and underinsured under health reform does not
begin to occur until 2014.
Stay tuned for some significant challenges in financing health
care delivery in Florida and in our nation.
Peace,
Jim Nathan
President, Lee Memorial Health System
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